Survey for Joining a "Hive Cell" (Mutual Support Small Group)

So you’d like to be in a small, mutual support network – also known as a “cell…”

• The purpose of this survey is to give everyone the best possible match in the soon-to-be-formed small groups.

• Please fill out this survey by July 22, 2015.

• We will contact you a couple of weeks later to let you know who is in your group.

• Your responses on this survey are confidential and will not be shared with anyone other than those doing the “matching.”

• If you have any questions, contact bratthive@gmail.com.

• Please also check out our website www.hivemutualsupport.net

*
1.What is your name?

*
2.How often would you like to connect with your group? (Check as many as you want.)

Daily

Weekly

Biweekly (every two weeks)

Other (please specify)

*
3.What are the ways that you’d like to connect? (Check as many as you want.)

In person

Phone

Facebook

Email

Skype/G-chat

Other (please specify)

*
4.Where would you like to meet with your group?

Group members’ houses/apartments

Public/community places like the library or The Root

Other (please specify)

*
5.We will try to match people up in a way that meets your transportation abilities and needs. Which town do you live in?

*
6.We will try to match people up in a way that meets your transportation abilities and needs. How do you get around? (Check as many as you want.)

I walk

I ride a bike

I drive my own car

I get rides from other people

I use a wheelchair

I ride the bus

Other (please specify)

*
7.Are there certain issues where you’d feel more comfortable if the other people in your group shared them in common with you? If so, what are they?

*
8.Who would you feel most comfortable being in a small group with? Is there anyone you would not feel comfortable being in a small group with? (You can use people’s names here. If you were not at the "mixer," this might be a hard question to answer. You can leave it blank, if that makes sense.)

*
9.What is/are your preferred contact method(s)? (Please check as many as you want and share that contact information.)

Phone

Facebook

Email

Other (please specify). Also, use this space to give your contact information!!!

*
10.What days and times are best for you to meet? Or, what days and times generally do not work at all?